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CMAJ. 2011 Aug 9;183(11):1257-61. doi: 10.1503/cmaj.110477. Epub 2011 May 30.

New Delhi metallo-β-lactamase-1: local acquisition in Ontario, Canada, and challenges in detection.

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University Health Network and Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex Department of Microbiology, Toronto, Canada.


New Delhi metallo-β-lactamase-1 (NDM-1) is a recently identified metallo-β-lactamase that confers resistance to carbapenems and all other β-lactam antibiotics, with the exception of aztreonam. NDM-1 is also associated with resistance to many other classes of antibiotics. The enzyme was first identified in organisms isolated from a patient in Sweden who had previously received medical treatment in India, but it is now recognized as endemic throughout India and Pakistan and has spread worldwide. The gene encoding NDM-1 has been found predominantly in Escherichia coli and Klebsiella pneumoniae. We describe the isolation NDM-1-producing organisms from two patients in Toronto, Ontario. To the best of our knowledge, this is the first report of an organism producing NDM-1 that was locally acquired in Canada. We also discuss the evidence that NDM-1 can affect bacterial species other than E. coli and K. pneumoniae, the limited options for treatment and the difficulty laboratories face in detecting organisms that produce NDM-1.

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